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General NPI Number Information
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NPI Number | 1346305117
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Entity Type | Organization
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Legal Business Name | FORNEY PEDIATRIC & MEDICAL CLINIC P.A.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 713 W BROAD ST SUITE 100
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 972-552-3330
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Fax | 972-552-3303
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Provider Business Mailing Address
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Address Line | 713 W BROAD ST SUITE 100
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 972-552-3330
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Fax | 972-552-3303
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAYAPRAKASH NARAYAN REDDY
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Credential | MD
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Telephone | 972-552-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G4198
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G4198
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | G2825
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License Number State | TX
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